Provider Demographics
NPI:1972974830
Name:CONNECTICUT PODIATRY GROUP,P.C.
Entity Type:Organization
Organization Name:CONNECTICUT PODIATRY GROUP,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DADDIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-933-8606
Mailing Address - Street 1:385 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-4312
Mailing Address - Country:US
Mailing Address - Phone:203-933-8606
Mailing Address - Fax:203-932-9571
Practice Address - Street 1:128 SALTONSTALL PKWY
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-2425
Practice Address - Country:US
Practice Address - Phone:203-467-8606
Practice Address - Fax:203-467-7256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT84976Medicare UPIN
CTT22937Medicare UPIN
CTU73697Medicare UPIN